Without medical insurance: “Half of our patients have an unclear residence status” | EUROtoday

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GJust when the toothache was nearly insufferable, the decisive turning level got here for Rodrigo Peres. An acquaintance instructed him that there was a dentist in Berlin who would deal with him. Just like that, with no well being card, with out papers, with out cash.

Peres, who doesn’t wish to reveal his actual identify to the general public, was initially skeptical. Why ought to somebody look after him, a migrant who’s staying in Berlin illegally, free of charge? The man in his late twenties arrived from Brazil a 12 months in the past and has no residence allow and no entry to statutory medical insurance. But the acquaintance reassured him: the dentist was serving to out of conviction that he did not even have to provide his identify.

Just a few weeks later, Peres is sitting in a small room in Berlin-Wilmersdorf within the west of town. It’s a Friday afternoon in November, dentist Cecilia Cseke is having her session and, sporting an FFP masks and blue plastic gloves, she’s leaning over Peres, who’s been there for the second time.

Quelle: Amin Akhtar

The entrance to the practice in Berlin-Wilmersdorf

The entrance to the observe in Berlin-Wilmersdorf

Quelle: Amin Akhtar

Cseke is a part of the medical workforce at “Maltese Medicine for People without Health Insurance” (MMM), a predominantly voluntary medical observe that has been offering free medical care to these in want since 2001, particularly in acute instances and superior diseases. There at the moment are 18 extra places in Germany. Different specialties are housed in an extended hallway: common drugs, dermatology, orthopedics, pediatrics, dentistry and gynecology.

Tuesday to Friday, sufferers who do not need entry to the common healthcare system are handled right here from 9 a.m. to 2 p.m. Last 12 months there have been greater than 1,500, 17 % of whom had been kids below the age of seven. The observe is financed half by the Berlin Senate and half by personal donations, such because the Postcode Lottery.

Experts assume that the variety of unreported instances is excessive

According to the Federal Statistical Office’s microcensus survey, round 61,000 individuals in Germany didn’t have medical insurance in 2019, most of them self-employed and unemployed. However, the statistics solely take note of those that are registered in Germany and have a authorized residence allow.

Experts assume that the variety of unreported instances is more likely to be a lot greater. Jürgen Wasem, a famend well being economist on the University of Duisburg-Essen, estimates the quantity to be between half one million and one million individuals. The support group “Doctors of the World” additionally speaks of a number of hundred thousand individuals.

The group of sufferers on the Maltese in Berlin could be very blended. “Approximately half of our patients have an unclear residence status, the other half mostly come from the EU, third countries and Africa. Many of them work illegally and have no access to regular health insurance,” says Felicitas von Wietersheim, who has managed the observe since 2016.

Practice manager Felicitas von Wietersheim

Practice supervisor Felicitas von Wietersheim

Quelle: Amin Akhtar

People with no residence allow are theoretically entitled to therapy for acute diseases or ache, however typically keep away from going to the physician for worry of deportation. In Malterser’s observe, this consists of Vietnamese and folks from Ghana. Asylum seekers from the Arab area, however, hardly ever come as a result of they go to regular physician’s places of work in the course of the ongoing asylum course of.


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Another group of sufferers are individuals who enter Germany legally however are employed with no work allow, for instance in development or agriculture. They additionally haven’t any medical insurance, for instance migrants from Serbia or Albania. EU residents who aren’t insured of their residence nation and are due to this fact not entitled to European medical insurance, akin to Bulgarians, are additionally repeatedly affected.

But Germans additionally come into observe, they usually did so final 12 months right here seven % of all sufferers. Many of them are self-employed and privately insured, says von Wietersheim. “At some point things are going badly economically, they can no longer pay their contributions and end up in debt with their health insurance company.” Many then slip into the so-called emergency tariff, which suggests they solely have restricted entry to well being companies.

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Katja Samuel, senior medical radiological assistant, prepares the X-ray of a woman who has fled Ukraine.

Switching to statutory medical insurance is then solely attainable below strict circumstances; The particular person involved should, for instance, change to an employment place and should not exceed the age of 55. In this manner, the legislature desires to forestall residents from initially benefiting from the cheaper contributions of personal medical insurance after which being burdened by statutory medical insurance as they become old.

It turns into significantly difficult for the observe when sufferers need to be referred to specialists or to hospital. “We have partner practices that offer a reduced rate for our patients,” says von Wietersheim. The Maltese observe tries to pay for the sort of continued therapy, and the prices of some medicines are additionally lined.

“The accusation of parasitism definitely doesn’t apply here.”

However, with costly therapies, the monetary restrict is rapidly reached. On this Friday afternoon, a Vietnamese lady got here to the observe with persistent stomach ache. General practitioner Barbara Vonneguth-Günther want to make a referral for a colonoscopy, however the prices of 400 to 500 euros can’t be borne by the affected person or the observe. “I later call a gastroenterologist friend and try to convince him to treat the patients free of charge,” says Vonneguth-Günther.

General practitioner Barbara Vonneguth-Günther

General practitioner Barbara Vonneguth-Günther

Quelle: Amin Akhtar

Sometimes sufferers are very fortunate. For instance, in April 2022, when a Ukrainian refugee household got here to the observe with their nine-month-old son. Ukrainians even have entry to statutory medical insurance, however the registration course of takes time that these affected typically do not need. The Ukrainian child suffered from muscle losing, a life-threatening genetic defect, and was depending on treatment price 11,000 euros. The Maltese workforce contacted the manufacturing pharmaceutical firm Roche, which donated the boy’s month-to-month dose.

Emotionally, the work isn’t all the time simple for the volunteer docs, extra of whom are urgently wanted. “I saw a torture victim whose entire body was covered in welts. Or women who I suspect are forced into prostitution in Germany,” says Vonneguth-Günther. The authorities are usually not knowledgeable on account of medical confidentiality. In just one case did the workforce notify the youth welfare workplace as a result of a child born to homeless dad and mom confirmed extreme developmental issues on account of neglect.

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Child safety in a disaster

The police additionally contacted the observe workforce just a few months in the past, wanting details about a affected person who was about to be deported. “We refused to provide information because we are bound by medical confidentiality. Our practice is a protected space in which our patients trust us,” says von Wietersheim.

Does she perceive that some are essential if individuals with out the fitting to stay are handled freed from cost – and half of it on the expense of the Berlin taxpayer? “Everyone has the right to medical care,” says von Wietersheim. “That is the highest commandment of the solidarity community, and that is what we as Christians are committed to.”

But wouldn’t it really be honest if residents paid common contributions and, of all individuals, those that needed to depart the nation had been offered for anonymously? “I know the accusation of the parasites. “That definitely doesn’t apply here,” replies von Wietersheim. “We mainly provide acute care, so no German citizen has to wait longer for their appointment.”

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Rodrigo Peres could be very grateful for the help. The Brazilian left his homeland as a result of, as he explains, he felt discriminated in opposition to there as a black man with African roots. In Berlin he works in a restaurant and will get cash in his hand. He lives in an condominium that buddies of buddies gave him and avoids the police. He hopes that he’ll ultimately get authorized residency and have the ability to begin a household.

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